2006 – 2015 Defense expected to be 383 billion a year
The federal deficit grows by the same amount at 300 – 400 billion a year
In 2006 the gross increase in debt grew by 371 billion plus 179 billion for
Social Security plus 104 billion for other areas for 654 billion total

“Continuing on this unsustainable fiscal path will gradually erode, if not
suddenly damage, our economy, our standard of living, and ultimately our
national security.” GAO Comptroller General David M. Walker Testimony
before Senate Budget Committee February 15, 2006

Beyond 2010 the planned tax cuts dramatically decrease revenues for the
federal government by 100 billion, 200 billion and up to 400 billion a year
by 2016. The deficit is on course to increase to 12 trillion dollars or
over $30,000 for every person in the United States.


US Budget
Expenditures
Social Security 23% and rising
Non-Defense Discretionary 19% and falling - all of our favorite programs
Defense 16% and rising, actually more with costs in other areas, potential
for massive rise
Medicare 12% and rising
Interest on the debt 10% and rising, potential for massive rise if
inflation results from energy and other influences
Medicaid 7% and falling, (already 75% goes for chronic care and only 25%
goes to care for 75% of Medicaid recipients)
               major sources of funding for FP and rural and primary care
all falling with cuts in Medicaid by feds, internal cuts, and eroded by
chronic care
Other Means-Tested Entitlements 6%
Other mandatory 7%

Revenues
Income taxes 50%
Payroll taxes 30%
Corporate taxes 10%
Other 10%

The share of income taxes as a percentage of GDP is at an all time high,
now greater than during the 10% levels of WWII = Measures of a sluggish
economy and general inefficiencies in the nation, spending more to get
less.

Government is about lubrication and education is the lubricant.
Distribution makes sure all the parts are adequately lubricated. Health
care, prisons and other state budget costs are the friction that bogs down
the machine. Since the machines is about turning human potential into
reality, the friction costs can choke off lubrication and eventually grind
other parts to a halt.

The "Friction" locations with the most inefficiency are easily identified.
They are the states and cities that leave the most people behind during the
early years. The inefficiency can be measured in education ratios (per
capita spending to high school grad rates), in education outcomes (less
than high school education) in health care costs, in auto insurance costs,
in prison costs per capita, in welfare costs per capita, and other
measures. They are the states and cities with concentrations of rich and
poor. Too much oil can be a bad thing in the wrong areas, especially with
too much oil in one area and too little in others.

Those rich fail to maintain involvement and awareness and responsibility
and forget the the most efficiency involves involvement, volunteer efforts,
and including all in all systems.

Those poor face repeated frustrations and inequities and abuses tend to
recover more and more slowly from set backs and then realize that there is
just not a consistent plan that can help them succeed. Improving education
is not guarantee when schools and education are poor quality. Improving
income loses food stamps, assistance, and health care coverage. Day care
and transportation problems can impede progress with jobs and education.
Those on welfare are required to attend numerous meetings to qualify
because no one trusts anyone. Schools do IEP plans to give students a plan
for graduation and success, but the IEPs are driven by state reimbursement
more than a real plan of action. No such planning exists to help someone
escape poverty and there are few role models who escape who are still
visible. People disappear for a number of reasons, mostly not good. But
those who disappear for good reasons don't return. People who disappear for
bad reasons may be gone for awhile, but do return. Then there are the real
inequities of trying to deal with the courts - family court, welfare
mistakes, workers comp inequities, attempting to recover stolen items or
deal with delinquent landlords, those who scam them on cars and other
deals, court fines and costs, drug and alcohol encounters that do punitive
measures but nothing restorative, and prison time in situations guaranteed
to multiple problems in future years, for those that survive prison and the
transition back and a return to the same lack of support as before. The end
result is lots of real disability, lots of traumatic disability, and lots
of disability from general dysfunction.

For youth, the situation is a real problem, especially in the United States
lower income culture. Anyone "making it" as a professional athlete or music
guru is known throughout the youth. It appears that success is who you
know, not what you do. So you know more people and do less. Knowing more
people means knowing more of the people on the streets available as
compared to people at work trying to make it. For poor children there is no
balance of people and academic skills and dedication. There is survival,
there are authorities, and there is endless undisciplined time. The media
rarely show the hours, the effort, or the people involved in "making it."
The examples of those who make it from their neighborhood are missing since
they, or anyone else not connected to family leave. Also there are few
around that can help them to make it.

For the higher income kids, it truly is who you know and they or their
parents know all the right people. However knowing the right people is
different than working with people or understanding people, especially
those different than you. What you do is important too, and expected. Rich
youth are surrounded by numerous examples of those that have made it. They
have all the most efficient modes of education, especially a great start by
age 5 so they excel in academics. However they fail to integrate the
academics and the people skills. Most of all, they fail in awareness. Also
they may be better than other kids around them in test scores, but they are
mainly using the advantage of their socioeconomics, just enough to stay
ahead. Full development of human potential is lost as they never learned to
push themselves to see how far their minds or bodies or hearts would take
them. Unlimited in education and income, they face the greatest limitations
of all. The humble origin students that had to push the envelope constantly
throughout life just to make it show no signs of leveling off as they catch
and pass the priviledged. First they had to pass the barrier of doing
slightly better than those around them. Their sights had to be much higher.
They they had to figure out transitions to academics, college preparation,
career orientation, admissions, top study skills, and more. Their people
skills and abilities were constantly honed. It takes them decades to
overcome gaps but they do. For those in medical education, they catch up
with the privileged types at measures at 2, 4, or 5 years after admission
.Their trajectory in college, basic science, and medical school appears
consistent with leaving others in their dust. As far as leaders for a
nation, many that we turn to in the most troubling times have had these
very different trajectories. I hope we have plenty around in the near
future.

Robert C. Bowman, M.D.
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